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背景在世界范围内,医院感染是不安全医疗、保健的最常见后果,但发展中国家此方面的数据很少,本文旨在对发展中国家的医院感染流行病学资料进行评估。方法搜索电子文献数据库和1995—2008年间发表的一系列相关文献。研究包括来自发展中国家的完整或局部的与感染流行相关的数据,这些数据包含了所选择的所有医院感染、主要感染部位以及病原微生物资料。根据预设标准,将文献分为低质量和高质量两类,并对数据进行汇总分析。结果在搜索到的271篇文献中,有220篇纳入了最终的分析,仅能代表部分地区的数据,许多国家没有数据。其中118篇(53.64%)为低质量文献。总体而言,高质量研究报道中的感染患病率高于低质量研究报道。在发展中国家的高质量研究中,医院感染的平均患病率为15.5/100名患者(95%CI:12.6～18.9),远远高于欧洲和美国的报道;成人ICU医院感染平均发病密度为47.9/1 000住院日(95%CI:36.7～59.1),至少是美国报道的3倍。医院感染中居首位的是手术部位感染,平均累积发病率为5.6/100台次手术,显著高于发达国家的报道。革兰阴性杆菌是医院内最常见分离细菌。仅有8篇文献报道54.48%(158/290)的金黄色葡萄球菌为耐甲氧西林金黄色葡萄球菌(MRSA),有关细菌耐药性的文献很少。结论在发展中国家,医院感染负担很重。研究结果提示,发展中国家需要加强监测和改善感染控制措施。
Background In the world, nosocomial infection is the most common consequence of unsafe medical and health care. However, data from developing countries are scarce. This paper aims to evaluate the epidemiological data of nosocomial infections in developing countries. Methods To search the electronic literature database and a series of related articles published in 1995-2008. The study included complete or partial data on the prevalence of infection from developing countries that included all selected nosocomial infections, major sites of infection, and pathogenic microbiological data. According to the pre-set criteria, the literature is divided into two categories of low quality and high quality, and the data are summarized and analyzed. Results Of the 271 searched articles, 220 were included in the final analysis, representing only the data in some areas, with no data in many countries. 118 of them (53.64%) were low-quality literature. Overall, the prevalence of infections in high quality research reports is higher than that of low quality studies. In high-quality studies in developing countries, the average prevalence of nosocomial infections was 15.5 / 100 (95% CI: 12.6-18.9), much higher than reported in Europe and the United States; the average incidence of nosocomial infections in adult ICUs 47.9 / 1,000 hospitalizations (95% CI: 36.7-59.1), at least three times reported by the United States. The first place in hospital infection was surgical site infection with an average cumulative incidence of 5.6 / 100 surgeries, significantly higher than those reported in developed countries. Gram-negative bacilli are the most commonly isolated bacteria in hospitals. Only 8 articles reported that 54.48% (158/290) of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus (MRSA), and there was little literature on bacterial resistance. Conclusion In developing countries, the burden of hospital infection is heavy. The findings suggest that developing countries need to step up monitoring and improving infection control measures.